Tesis

Luaran Terapi Yodium Radioaktif 10 mCi Dosis Awal Pada Penyakit Graves: Respon Klinis dan Kepuasan Pasien = Therapeutic Outcomes of Initial 10 mCi Radioactive Iodine Therapy in Graves’ Disease: Clinical Response and Patient Satisfaction.

Latar Belakang: Sebagai gangguan tiroid autoimun tersering, dengan karakteristik "remitting and relapsing disease" dan beragam komplikasi yang berdampak pada penurunan kualitas hidup. Terapi I-131 merupakan pilihan definitif dengan kelebihan tidak invasif, relatif murah, dan efektif dengan pencapaian remisi 81,5% dalam 3-6 bulan. Namun respon terapi ini sangat bervariasi dan belum ada satu faktor pun yang terbukti dapat diandalkan dalam memprediksi hasilnya. Belum ada penelitian yang menilai luaran terapi I-131 fixed dose berdasarkan aspek klinisi berupa pencapaian responder dan aspek pasien berupa tingkat kepuasan pasien. Tujuan: Menilai luaran penyakit Graves pasca 12 bulan terapi I-131 fixed dose 10 mCi berupa proporsi responder serta faktor-faktor yang memengaruhinya, dan mengevaluasi tingkat kepuasan pasien. Metode: Penelitian ini merupakan studi kohort retrospektif, dilanjutkan dengan potong lintang terkait kepuasan terhadap 72 subjek pasien penyakit Graves yang menjalani terapi I-131 fixed dose 10 mCi dosis awal pada periode Januari 2020 hingga April 2024 dari registri kedokteran nuklir RSCM. Luaran terapi dinilai berdasarkan proporsi responder dan tingkat kepuasan pasien pada penyakit Graves setidaknya 12 bulan pasca terapi I-131. Penilaian responder berdasarkan respon fungsi tiroid dari evaluasi laborat FT4-TSHs dan juga respon perubahan regimen terapi 12 bulan pasca terapi I-131. Kategori non responder apabila tidak ada perubahan dari kondisi hipertiroid subklinis/klinis sebelum dan pasca terapi I-131, atau perburukan; dan tidak ada perubahan dosis OATi, atau kebutuhan dosis OATi yang lebih tinggi pada 12 bulan pasca terapi I-131. Faktor prediktor yang dianalisis meliputi usia, durasi penyakit Graves, kebiasaan merokok, volume kelenjar tiroid dan tangkapan skintigrafi tiroid pre terapi. Data kualitas hidup diambil secara wawancara menggunakan skala VAS untuk menilai tingkat kepuasan pasca 12 bulan terapi terhadap 62 subjek. Hasil: Proporsi status responder terhadap 12 bulan pasca terapi I-131 fixed dose 10 mCi dosis awal sebesar 70,8% dengan faktor volume kelenjar tiroid terbukti memengaruhi luaran 12 bulan pasca terapi. Tingkat kepuasan sebagian besar pasien penyakit Graves pasca terapi I-131 fixed dose 10 mCi dosis awal baik (72,9%). Simpulan: Terapi I-131 fixed dose 10 mCi terbukti efektif pada penyakit Graves dengan proporsi responder mencapai 70,8% setelah 12 bulan dan dipengaruhi oleh volume tiroid berpengaruh terhadap keberhasilan. Mayoritas pasien merasa puas terhadap hasil terapi.
Kata kunci: Penyakit Graves, terapi I-131, responder, tingkat kepuasan


Background: Graves' disease is the most common autoimmune thyroid disorder, characterized as a remitting and relapsing condition with various complications that may impair quality of life. I-131 therapy as one of the definitive options, has the advantages of being non-invasive, affordable, and effective, achieving remission rate up to 81.5% within 3-6 months. However, treatment responses vary widely, and no single predictive factor has been reliably established. To date, no study has assessed the outcomes of fixed-dose I-131 therapy from both the clinician’s perspective—based on responder status, and the patient’s perspective—based on satisfaction levels. Objective: To evaluate the treatment outcomes of Graves’ disease 12 months following initial I-131 therapy at a fixed 10 mCi dose, focusing on the proportion of responders, identifying associated predictive factors, and assessing patient satisfaction. Methods: This is a retrospective cohort study, followed by a cross-sectional assessment of satisfaction involving 72 patients with Graves’ disease who underwent initial I-131 therapy at a fixed dose of 10 mCi between January 2020 and April 2024, based on data from the Nuclear Medicine registry at RSCM. Treatment outcomes were defined by proportion of responders and satisfaction level at least 12 months post-I-131 therapy. Responder status determined by thyroid function response via FT4-TSHs laboratory results and changes in treatment regimen 12 months after therapy. Subjects were categorized as non-responders if they showed no improvement or worsening from subclinical/clinical hyperthyroidism and required no dose reduction or higher doses of antithyroid drugs (OATi) at 12 months post-treatment. Predictive factors analyzed included age, duration of Graves’ disease, smoking habits, thyroid gland volume, and thyroid scintigraphy uptake before therapy. Quality of life data were collected through interviews using a Visual Analog Scale (VAS) to assess satisfaction among 62 subjects 12 months post-therapy. Results: The proportion of responders at 12 months following initial I-131 fixed dose therapy (10 mCi) was 70.8%, with thyroid gland volume shown to significantly influence treatment outcomes. Most patients with Graves' disease reported good satisfaction levels post-therapy (72.9%). Conclusions: I-131 therapy with a fixed 10 mCi dose proved effective in treating Graves’ disease, achieving a 70.8% responder rate at 12 months. Treatment success was influenced by thyroid volume, and the majority of patients expressed satisfaction with the therapeutic results.
Key words: Graves' disease, I-131 therapy, responders, satisfaction level